I am an intern in emergency medicine at Detroit Receiving Hospital. I’ve been doing this job for a whole 5 months, and just the other day I realized something that now resonates with me.

Before I went to medical school, I came across a fair number of physicians offering me one piece of advice: “Don’t go to medical school.”

I’m sure they had their reasons, such as a changing health care system, worsening insurance reimbursement, and more and more paperwork. Obviously I disregarded their advice because, well, here I am, “doctoring” and whatnot. But I started to wonder, if I were being honest with myself, what would I tell an impressionable undergrad who asked me about pursuing a career in medicine?

And here it is I would say that if there is anything else in this world you would rather do besides medicine, do that. And here’s why.

Last week I was on-call in the neuro­critical care unit. EM residents at Receiving have several ICU rotations designed to give us the responsibility and the capability of caring for Detroit’s sickest of the sick. And while I embrace that opportunity, nothing prepares you to be the “bad guy.” Because let’s be honest, that’s what we are. No one comes to the emergency department because they’re having a great day and they want to share that joy with you. They come because they feel terrible, they’re scared, and/or they have no place else to go. And when someone comes in especially sick, we have the responsibility of telling his or her family just how bad it really is.

The day before Thanksgiving, a 52-year-old woman was leaving her mother’s house to meet other family members for dinner. She was at the front door, ready to walk out, when she suddenly told her mom she had this “terrible headache.” Seconds later she felt dizzy and collapsed to the floor. Her mother immediately called EMS. On arrival to the emergency department, the woman was unresponsive to verbal stimuli.

Her pupils were 3 mm bilaterally and sluggish to react. CT of the head showed a large intraparenchymal and intraventricular bleed, and neuro ICU (a.k.a., me) was consulted. When the attending and I arrived in the emergency department, the catastrophic nature of the event was clear. Nevertheless, the neurointensivist placed a ventriculostomy while one of the senior EM residents and I placed a central line.

Over the next several days, I watched as a formerly independent, vibrant, energetic woman (according to her family) lay comatose as we attempted five rounds of intraventricular TPA in a long-shot effort to help her wake up. And I was responsible for telling the family each time that it had failed. By the third day, there was no one that family hated more than me. They were angry and, really, who can blame them? Soon after that patient was admitted, that family began to realize I was never going to give them good news. I was always going to be the “bad guy.”

On the fifth day, the family withdrew care. And those family members who had “hated” me the most gave me a hug and thanked me. Why? Because someone has to be the “bad guy.” Someone has to be the bearer of bad news. As emergency medicine physicians, even in our off-service time outside the emergency department, this is the hard job we are capable of doing. And I think many of us take pride in doing it well.

Different specialties in medicine are difficult for their own reasons, but it’s always easier to give good news. I think a big part of emergency medicine is saving those you can and humbly acknowledging those you can’t.

So, I’ll say it again: If there is anything else in this world you would rather do besides medicine, do that.

As for me, I’m doing exactly what I’m supposed to be doing, being the “bad guy.”

Dr. Maso is an intern at Detroit Receiving Hospital. She also holds a master’s degree in public health with an emphasis in community health.